CAN’T ANY­ONE HEAR ME?

The pa­tient was in a coma – all the doc­tors said so. The only one who dis­agreed? The pa­tient

Reader's Digest Asia Pacific - - News - TOM HALLMAN

In a coma, Richard Marsh watched help­lessly from his hospi­tal bed as doc­tors asked his wife whether they should turn off his life sup­port ma­chine.

Richard Marsh awak­ened to the rhyth­mic beep­ing of a ma­chine. Some­thing was lodged in his throat. He couldn’t cough. He couldn’t sit up. He couldn’t move. What’s go­ing on?

He tried to move his legs, arms and fin­gers. Even his eye­balls, he re­alised, wouldn’t budge. He felt some­one put drops in them to keep them moist, but he couldn’t make out who it was.

What’s wrong with me? He could only stare in one di­rec­tion – straight ahead.

With his pe­riph­eral vi­sion, Richard could see his wife off to his right. He heard her talk­ing to a man next to her, a man who seemed to be in sur­gi­cal scrubs.

“It doesn’t look good,” the man said. What doesn’t look good? “His chance of sur­vival is very small.” They’re talk­ing about me. Richard willed his body to re­spond: with his voice, his eyes, his hand. Noth­ing.

“You need to pre­pare for the worst,” the man in scrubs told Richard’s wife, Lil­iana Gar­cia. Though som­bre, she didn’t cry. A regis­tered nurse at a hospice cen­tre, she quickly turned pro­fes­sional, ask­ing the doc­tor clin­i­cal ques­tions as if the man in the bed were just another pa­tient, not the love of her life. I’m in here. And then his world faded to black.

HE HADN’T FELT well two morn­ings be­fore. Lil­iana no­ticed he looked a lit­tle pale. But Richard didn’t want her hov­er­ing and fuss­ing over him as if he were her pa­tient. He said he’d be fine and in­sisted she go to work. That was his way. Once alone, Richard re­laxed on the couch be­fore he had to leave for school. He taught foren­sic sci­ence and eco­nom­ics near his home in Napa, Cal­i­for­nia, and he was con­sid­ered one of the high school’s pop­u­lar teach­ers.

He stood up, ready to leave for work, when he felt as if he were on the deck of a small boat in choppy seas. He grabbed the edge of a ta­ble and made his way to the tele­phone. He called his wife’s of­fice and left a mes­sage for her to call him.

Richard sat back in a chair at his desk. Some­thing was wrong with him. He rarely drank, never smoked and re­ally was in great shape. At 60 years old, he stood 1.8 me­tres tall and weighed 98 kilo­grams. He pumped iron at the gym, a habit

he’d started dur­ing his first ca­reer as a po­lice of­fi­cer.

The phone rang­– Lil­iana call­ing him back. “Come home,” he told her.

All Lil­iana heard was a gar­bled voice. Then she called emer­gency ser­vices.

Min­utes later, Richard was rushed to the hospi­tal in an am­bu­lance. Numb­ness had started in his feet and crept up his legs to his waist. He felt him­self los­ing con­trol of his mus­cles. He couldn’t swal low. To save him, an ER team put him un­der and in­serted a breath­ing tube down his throat. He was then given med­i­ca­tion to fight a stroke that doc­tors be­lieved was be­ing caused by a clot.

Af­ter doc­tors did what they could, nurses wheeled Richard to in­ten­sive care. And then they waited.

ONCE HE HAD AWAK­ENED, and even though he was paral­ysed, Richard felt sen­sa­tions when doc­tors and nurses touched him. I don’t feel sick. I just can’t move. Slowly, he re­alised he was trapped in a prison that was his body. He heard the doc­tor ex­plain to Lil­iana that her hus­band was in a coma. Richard heard the blunt di­ag­no­sis: a two per cent sur­vival rate. “If he lives, ex­pect se­vere brain dam­age … Lit­tle hope … Best out­come is that he sur­vives but lingers in a veg­e­ta­tive state … You need to con­sider tak­ing him off life sup­port,” Richard re­calls hear­ing the doc­tor say.

He re­mem­bered the con­ver­sa­tion he and Lil­iana had had three years ear­lier, when they got mar­ried. They dis­cussed end- of- life sce­nar­ios. They agreed that i f, God for­bid, ei­ther of them re­quired life sup­port for what­ever rea­son, the other spouse needed to pull the plug, out of com­pas­sion and love.

Richard heard his daugh­ters’ voices. Dis­tant. Per­haps in a hall­way? Lil­iana told the doc­tor she needed to dis­cuss the is­sue with her hus­band’s daugh­ters, adult chil­dren from a pre­vi­ous mar­riage. I guess I’m dy­ing. Lil­iana re­turned. The fam­ily, she told the doc­tor, had agreed to wait a few days to see how Richard pro­gressed. The girls, she ex­plained, weren’t ready to let their fa­ther go. Nor was she pre­pared to lose her hus­band.

Through­out the day, friends came and stood by Richard’s bed. They talked about old times. They told him they loved him and how good he looked.

Richard heard the blunt di­ag­no­sis: a two per cent sur­vival rate

His daugh­ters came with the grand­chil­dren. As they leaned to­wards his face, Richard saw the tears in their eyes, even as they shared words of en­cour­age­ment. No. I’m here! He felt lips on his fore­head. A char­ac­ter in a macabre scene in a hor­ror movie, Richard had only his thoughts to keep him oc­cu­pied. He’d never go home again, teach, or kiss his wife. He’d lie in a hospi­tal bed – the ul­ti­mate soli­tary con­fine­ment – for years. Or his fam­ily would sign the pa­pers and wait by his side as the doc­tors did what was nec­es­sary to let him slip away.

Richard heard the staff talk­ing and laugh­ing in the hall­way. Life, the ev­ery­day life he’d taken for granted, was so close and yet so far away.

Per­haps death would be a bless­ing, he con­cluded. Richard ac­cepted the in­evitable. He re­signed him­self to the end. If it’s go­ing to hap­pen, let it hap­pen. The next morn­ing, a neu­rol­o­gist stopped in the ICU and hud­dled with other doc­tors at his bed­side. Richard heard part of the con­ver­sa­tion: “Has any­one checked to see if he’s in there?”

The neu­rol­o­gist leaned over, so close that Richard could feel the man’s breath on his cheek: “Rich, if you can hear me, blink your eyes.” Blink … Try … When Richard was a cop, he was trained to deal with scary events head- on. But now … What if he couldn’t blink? He drew on the cop in­side, the strong man, the rock. He was good with vict ims, those suf fer­ing t re­men­dous loss. In this in­stance, Richard Marsh was the vic­tim. Blink! And then … a blink so ex­cru­ci­at­ingly slow that the neu­rol­o­gist couldn’t be sure what he’d seen. “Rich, blink your eyes again. Can you hear me?” A … blink. They knew.

EX­TEN­SIVE TESTS re­vealed that Richard had suf­fered from a con­gen­i­tal anom­aly in one of two ar­ter­ies in his brain. One artery was fully formed but blocked. The other artery had never formed, an un­di­ag­nosed birth de­fect that hadn’t caused Richard prob­lems un­til now.

With the blood sup­ply com­pro­mised by that block­age, Richard had suf­fered a brain stem stroke. The stem, which con­nects the brain to the spinal cord, con­trols nearly all bod­ily func­tions. His heart was beat­ing, but there was vir­tu­ally noth­ing that ­Richard could vol­un­tar­ily will his body to do.

“Has any­one checked to see if he’s in there? Rich, if you can hear me, blink”

With Lil­iana by his side, doc­tors ex­plained that Richard suf­fered from ‘locked-in syn­drome’, mean­ing he was lit­er­ally locked in his body.

They asked him ques­tions: blink once for yes, twice for no. It took an ex­tra­or­di­nary ef­fort for Richard to get his eyes to work.

Up to 70 per cent of peo­ple di­ag­nosed with the syn­drome die within a short pe­riod of time. Of those who do sur­vive, only a hand­ful re­cover enough to lead a nor­mal life.

But be­fore he could even hope for such an out­come, Richard would have to en­dure new ter­rors.

RICHARD WAS MOVED from the ICU to a hospi­tal where spe­cial­ists would let his body de­cide the course of the treat­ment. Be­cause he could not swal­low, doc­tors per­formed a tra­cheotomy, mak­ing an in­ci­sion in his wind­pipe and in­sert­ing a tube so Richard could breathe and nurses could suc­tion out the saliva that would oth­er­wise drain into his lungs. Hor­ri­ble. But they know I’m here. To help Richard com­mu­ni­cate more eas­ily, Lil­iana bought a let­ter board for the fam­ily to hold in front of him. The board had four quad­rants, each con­tain­ing sev­eral lines with five let­ters in each line, and an empty box in the mid­dle to write his mes­sage in. Richard would look at the board. His fam­ily would have to fol­low his eyes to the cor­rect quad­rant. This cor­ner? A blink. First line? Two blinks. This let­ter? Two blinks. Sec­ond line? Blink. This let­ter? Two blinks. Ev­ery word, slowly spelled out. As tough as the days were, the nights, af­ter his fam­ily had gone home, were hell. The staff didn’t use the board, nor were they con­stantly around to take care of his ev­ery need. Trapped, Richard was alone and scared. Flu­ids built up in his throat, chok­ing him, and no one was around to suc­tion them out for him. His room­mate heard him struggling to breathe and used his call button to get the nurses to help.

When his fam­ily ar­rived one morn­ing, Richard looked wildly at the let­ter board. Slowly, he made his wishes known: Get me out of here.

Days later, his wife moved him to a hospi­tal closer to their home. Phys­i­cal and oc­cu­pa­tional ther­a­pists started to work with him more ag­gres­sively, try­ing to get his body to func­tion fully again. Days passed. There’s no re­turn­ing to nor­mal. Then weeks. Hard­est thing I’ve done in my life. Then one day it hap­pened – ­Richard moved the big toe on his left foot. Two weeks later, he moved his head from side to side. Days later, he wig­gled a foot. Af­ter another day or two had passed, he could shake his legs. His fam­ily mem­bers cried,

laughed, and hugged one another with each new vic­tory.

More than two months af­ter his locked- in di­ag­no­sis, Richard did some­thing he’d taken for granted his en­tire life – he raised his hand and touched his nose. And then he walked, a big tod­dler tak­ing the first few wob­bly steps, rocking from side to side with his walker to keep his bal­ance as he slowly made his way from his bed to the door of his room and back, a ther­a­pist close by his side in case he fell.

Ex­actly four months and nine days af­ter the stroke, af­ter more painful and painstak­ing re­hab, Richard Marsh walked through the front door of his home un­der his own power. He sat in his chair. He was back.

RICHARD WAS FOR EVER changed. He’d lost 23 kilo­grams of mus­cle, and when he came home he was so weak that he couldn’t lift a car­ton of milk. Phys­i­cally, he re­built his life. It took a year, but he re­turned to his fight­ing weight, back pump­ing iron at the gym.

Emo­tion­ally, Richard no longer got eas­ily ir­ri­tated or wor­ried over the lit­tle things. He be­came less con­trol­ling. He even re­tired from teach­ing and took over the house­hold du­ties while Lil­iana con­tin­ued to work. He found plea­sure in life’s sim­plic­ity.

Some­one gave him the book The Div­ing Bell and the But­terf ly, the mem­oir of Jean-Do­minique Bauby, a jour­nal­ist who suf­fered a stroke and re­mained locked in for the rest of his life. Bauby dic­tated his story to his pub­lisher’s ed­i­to­rial as­sis­tant by blink­ing his one good eye in re­sponse to an al­pha­bet re­ar­ranged by how of­ten let­ters are used. He died two days af­ter the book was pub­lished. Richard read two chap­ters and promptly gave the book away. Un­like Bauby, Richard was very much alive.

He would never for­get wak­ing up in the ICU and the long jour­ney to es­cape his prison. He’d been given a sec­ond chance, a pre­cious sec­ond chance. He vowed, daily, to never squan­der the gift.

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